Surgical instrument for implanting capillary seeds containing radium emanation



Jan. 20, 1931. um 1,789,767

SURGICAL INSTRUMENT FOR IMPLANTING CAPILLARY SEEDS CONTAINING RADIUM EMANATION Filed Feb. 19, 1926 2 Sheets-Sheet 1 Fig.1. Fig.2. Fig.3. Fig.4. Fig.5.

'illllllllllllllllm "/IIlIl/I/l/I/II/l/b 2299mm:555mm:

gwwmtoz $055M Mum 351, SW 0 7 Jan; 20,1931. I J. MUIR 1,189,767

SURGICAL INSTRUMENT FOR IMPLANTING CAPILLARY SEEDS CONTAINING RADIUM EMANATION Filed Feb. 19, 1926 2 Sheets-Sheet 2 305mm Mum Elttozmg Patented Jan. 20, 1931 UNITED STATES sunercnr. msrnurrnnr FOR IMPLANT'ING oArIIiLAnY snaps com-amine RADIUM 7 PATENT, OFFICE I JOSEPH .MUIR, OF NEW YORK, N. 'Y., ASSIGNOR TO THEBADIUM EMANATION CORPO- BATION, OF NEW YORK, N. Y., A. CORPORATION OF DELAWARE ATION I Application filed February 19, 1926. Serial No. 89,402.

This" invention relates to the-provision of an instrument for implanting radium emanation capillary tubes or seeds in solid bladder tissue or the like through the cystoscope.

The cystoscope referred to is an instru the cystoscope. Between the source oflight and the opening of the tube is an.elevator which is merely a lever adapted to direct the position of the end of the bougie introduced through the cystoscope and into the bladder. The elevator permits the bending of the end of the bougie to an angle of approximately 90.

As is clear from the examination of F igures 7 to 16 inclusive, the seed tube or bougie entrance on the vision end of the cystoscope is set at an angle of approximately 35 to the main tubular body of the cystoscope. Any bougie in being passed through the cystoscope is subjected totwo bends: first, the

permanent entrance bend and second, the adjustable bend caused by directing the end of the bougie by means of the elevator.

The primary object of the present invention is toprovide an instrument which will permit the implantation of radium emanation tubes in the bladder through a cystoscope. Briefly, the instrument is characterized by the following features:

(1) It is provided with a flexible cannula slidably fitting in the cystoscope, the flexibility of the cannula being sufficient to take the initial bend of the side tube of the cystoscope and also the final sharp bend induced by the manipulation of the cystoscope elevator; and at the same time permit the free passage of seeds or tubes containing radium emanation through the bend of cannula when the-tubes are pushed forwardly by the plunger.

A tubular piercing needle is permanently attachedto the bladder end of the flexible cannula. V

(3) The flexible cannula has a tubular metal barrel at the end remote from the bladder end, said barrel embodying a load- 111g slot for seeds or tubes and consisting of a countersunk groove having walls extending at an acute angle toeach other and to the axis of the initial barrel.

' (4) A plunger portion is provided fitting slidably along the tubular barrel, cannula and needle, the length of the plunger'proper being approximately equal to the overall length of the cannula, needle and barrel.

to take the first bend of the cystoscope and thereafter the sharp bend induced by the elevator. At the same time, the plunger when introduced into the cannula must give V the instrument high resistivity so that when pressure is applied, holding the instrument by the heavy metal barrel body, the pressure will be transmitted. along the instrument and the two bends sufiiciently to pierce the diseased tissue with the needle at the end of the flexible cannula. In order that the plunger may accomplish the above .it preferably comprises a flexible main portion and a flexible and highly resilient thin end portion. The'flex- V 'ible main portion takes the first bend of the cystoscope, while the flexible and highly resilient thin end portion takes the verysharp and variable bend induced by the manipulation of the cystoscope elevator. This fiexible and highly resistant end portionof the plunger may consist of a' relatively short length of wire cable which may betermed an ejector terminal. Such a flexible end plunger portion is pliable and at the same Instead time resilient and self-sustaining. of using an end plunger portion composed of pared to the main plunger portion.

I The plunger must be highly resilient and flexible in order a wire cable or spring, a relatively thin and resilient wire may be attached to thevmain plunger portion, said end plunger wire being relatively of materially less diameter ascom- (5) While the above describedform of" plunger gives fairly satisfactory results, it is preferred that the instrument plunger be provided with an end plu ger plug a d this is ejector terminal. 19 functions similarly to the thin end plunger portion 15which is hi hlyfiexible and resilient. Both forms of? plungers may be characterized by having main flexible: plunger portions 14 and 18 and integral therewith supplemental ejector plunger portions 15 and 19 which are both flexible and resilient. provided with a head 20.

The use of the instrumentwill be clear from an examination of Figs. 10 to 16 inclusive. 7 shows the cystoscope 21 in place in a bladder 22 and the'fiexible instrument being passed into the cystoscope under visual observation until the tip of the implantation instrument appears in thelield of vision, the cystoscope '21 havingat the bladder end 24: thereof a source of light to secure vision. As soon as the needle 2 appears in the field of vision, theoperator as shown in Fig. 8 directs the point thereof, to the chosen spot by proper .manipulation of the cystoscope and its elevator, and by advancing the instrument according to need. The elevator controlled by elevator screw 23. i

The needle point 5 of the instrumentbeing in the position desired for implantation, the flexible cannula is pushed ahead, its gradual entry into the tissue being underconstant observation. This isshown in Fig. 9. The

depth of penetration can be easily gauged by j the eye as well as the feel of the cannula as it advances into the cystoscope 21. As should benoted throughout this procedure, the

" plungers 15 or 19 depending upon which type of instrument is used remain undisturbed. As shown in Fig. 10, the needle tip ofthe instrument and part of the carrier having been introduced as far as desired, for the placement of the first seed, the plunger 13 comprising the main plunger portion 1 the highly flexible and resilient ejector portion 15 and the end plunger plug 16, is entirely withdrawn. Visional operation may be safely interrupted at this point, as the needle is firmly embedded in the tissue. Thereafter, as shown in Fig. 11, the instrument or carrier may be loaded with the seed. The operator continues to hold the cystoscope and instrument, and anassistant places a seed in the loading slot, holding the instrument or carrier with a detachable handle.

As shown in Fig. 12, the plunger portion of the instrument is now introduced by an a sistant into the cannula 1. and care is exercised to push the seed safely into the lumen. he pressure is continued until only about the last one-half inch of the wire plunger remains outside of the cannula 1 and bar rel 6. As shown in Fig. 13 the seed is now pushed home preferably under visual opera-' tion as shown by the eye in front of the cystoscope. /Vhenever other seeds are to be implanted in thesame portal of entry, the plunger portion of the instrument is with- The plunger 13 is drawn as shown in Fig. 1 1 to whatever distance desired, the visual observation of the embedded portion of the carrier affording a perfect estimate as to distance. As many seeds as are considered necessary, are implanted 1nto the same portal of entry, 1n successive steps. The last seed forany given then proceeds to distribute the seeds as above,

setforth. i r

This application is in part a continuation of application Ser. No. 7 09,800, filed April 29. 1924 by Joseph Muir. 7

I claim: Y Y

1. An instrument for implanting capillary seeds or tubes containing radium emanation in solid'tissue in the. bladderor the -like through an operating cystoscope, such im-- plantation requiring extreme care in 'manip ulating the lnstrument'm order to accuratelyradiate the diseased tissue, avoid loss ofthe I I emanation tube, and subject the emanation operator to a minimum exposure ofradlum ible cannula having a tubular piercing needle the bladder end thereof, a tubular receiving member at the other end of the cannula, a receiving opening-therein for the insertion of emanation seeds, and i a plunger slid ably fitting in; said cannula and receiving member and adapted to force theemanation operator to a minimum exposure of radium. emanatmn, comprising a resilient and flexible cannula consisting of a. wound wire whereby the cannula is adapted to take the initial bend of the side tube of the cystoscope I and also the final sharp bend induced by the manipulation of the cystoscope elevator, a tubular piercing needle at the bladder end of the cannula, a receiving member at the other end of the cannula, a receiving opening therein for the insertion of emanation seeds and a plunger slidably fitting in said cannula and receiving member and adapted to force the emanation tube therethrough and into or adjacent the diseased tissue, said instrument when in use permitting the free emanation, comprising a resilient and flex.

' cannula bends when the seed' is passage of the emanation seed through the pushed for Wardly by the plunger. l In combinatioina cystoscope and an instrument for implanting seeds or tubes containing radium emanation in solid tissue and operating through said cystoscope, such implantation requiring extreme care in manipulating the instrument in order to accuthe emanation tube therethrough and into v and adjacent the diseased tissue.

4. In combination, acystoscope and an instrument for implanting seeds or tubes containing radium emanation in solid tissue and operating throughsaid cystoscope, such implantation requiring extreme care in 'manipulating the instrument in order to accurately radiate the diseased tissue, avoid loss-of the emanation tube, and subject the emanation operator to a minimum exposure of radium V emanation, said instrument comprising a resilient and'flexible cannula consisting ofa wound wire whereby the cannula is adapted to take the initialbend of the side tube of the cystoscope-and also the'final bend induced by the manipulation of the cystoscope elevae' tor, a tubular piercing needle at the bladder end of the cannula, a receiving member at the other end of the cannula, a receiving opening therein for the insertion of emanation seeds and a plunger slidably fitting in said cannula and receiving member and adapted to force theemanation tube therethrough and into or adjacent the diseased tissue, said in strument when in use permittingthe free passage of the emanation seed through the cannula bends when the seed is pushed for- Wardly by the plunger. 7 i

5. An instrument for implanting capillary seeds or tubes containing radium emanation in solid tissue in the bladder or the like through an operating cystosoope, such implantation requiring extreme care in manipulating the instrument in order to accurately radiate the diseased tissue avoid loss of the emanation tube, and subject the emanation operator to a minimum exposure of radium emanation. comprising a resilient cannula having a tubular piercing end provided. at a point in its length inwardly of said end with a receiving opening communication with its bore,and an ejector member slidably fitting in the bore of the cannula and adapted barrel at the other end of the cannula, said to force the emanation tube therethrough and into or adjacent the diseased tissue. w

6. An instrument for implanting capillar' seeds or tubes containing radium emanation in solid tissue in the bladder or the like through an operating cystoscope, such implantation requiring extreme. care in manipulating the instrument in order to accurately radiate the diseased tissue, avoid loss of the emanation tube, andrsubject the emanation operator to a minimum exposure of radium emanation, comprising .a cannula having a tubular piercing end and provided at a point in its length inwardly of said end with a receiving opening in communication with its bore, and an ejector comprising a main plunger portion slidably fitting in the bore of the cannula, and a relatively flexible. andresilient terminal attached to the advancing end of the said plunger portion, said terminal being made'of wire to provide the proper resiliency. '4'. An instrument for implanting capillary seeds or tubes containing radium emanation in solid tissue in the bladder or V the like through ail-operating cystoscope, such implantation requiring extreme carein maniputhe bore of the cannula, and a relatively exible and resilient terminal extension carried by the forward end of the said main plunger portion and likewise slidably fittingin the bore of the cannula, said terminal extension being made of Wire to provide the proper resiliency.

8. An instrument for implanting capillary seeds or tubes containing radium emanation in solid tissue in the bladder or the like through an operating cystoscope, such implantation requiring extreme care in manipulating the instrument in order to accurately radiate the diseased tissue, avoid loss of the emanation tube, and subject the emanation operator to a minimum exposure of radium emanation, comprising a resilient cannula, a tubular piercing needle at one end thereof, a

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barrel having a receiving slot in communication with its bore, and a resilient ejector member slidably fitting 1n the bore of the cannula and in the bores of the barrel and needle,

the said ejector member being removable through that end of the instrument at which the barrel is located.

9. An instrument for implanting capillary seeds or tubes containing radium emanation in solid tissue in the bladder or the like 123,

through anoperating cystoscope, such implantation requiring extreme carein manipulatingthe instrument in order to accurately radiate the diseased tissue, avoid loss of the emanationtube, and subject the emanationoperator to a minimum exposure of radium emanation, comprising a resilient cannula,..a

tubular piercing needle at one end thereof, a barrel at the other end of the cannula, said barrel having a receiving slot in communication with its bore, and a resilient ejector member slidably fitting in the bore of the cannula and in the bores of the barrel and needle, said ejector member being removable through that end of the instrument at which the barrel is located, the walls of theslot being beveled to provide increased -dimensions e at the receiving side of the slot 10. An instrument for implanting capil-- lary seedsortubes containing radium emanation in solid tissue in the bladder or the like through an operating cystoscope, such implantation requiring extreme care in manipulating the instrument in" order to accurately'radiate the diseased tissue, avoid; loss of the emanation tube, and subject the emanation operator to a minimum exposure of radium emanation, comprising a resillent cannula, a tubular piercing needle at one end thereof, a barrel at the other end ofthe cannula, said barrel having a receiving slot in communication with its bore and a resil ient ejector member slidably fitting into the .fore of the cannula and into the barrel and needle and having attached thereto at its.

advancing end a flexible resilientfterminal.

11. An instrument for implanting capillary seeds or tubes containing radium emanation in solid tissue in the bladder or the like through an operating'cystoscope, such implantation requiring extreme care inmanipulating the instrument 1n order to accurately radiate'the diseased tissue, avoid loss of the emanation tube, and subject the emanation operator to a minimum exposure ofradium emanatlon, comprismg a resilient cannula having a tubular piercing end and provided at a point in its length inwardly of said end with a receiving opening in communication with its bore, and a resilient ejector member sildably fitting in the bore of the cannula.

,12. In combination, a cystoscope and an instrument for implanting seeds or tubes containing radium emanation in solid tissue and operating through said cystoscope, such implantation requiring extreme care in ma nipulating the instrument in order to accurately radiate the diseased tissue, avoid loss of the emanation tube, and subject the emanation operator to a minimum exposure of radium emanation, said instrument comprlsing a cannula having a tubular piercing diseased tissue.

comprising a mainplunger portion sli'dably :fitting in the'bore of the cannula and a rela tively'flexible and resilientterminalmade of wiretoprovide theproper resiliency attached "to the advancingend ofthe main plunger portion, the latter being adapted to bend induced ,by :the cystosco-pe elevator.

. 13. In combination, a cystoscope an instrument for implanting seeds or tubes containing radium emanation in solid tissue and operating through'said cystoscope, such im- 5 plantaticn requiring extreme care in manipulating the instrument in order to accurately radiate the diseased tissue, avoid loss of'the emanation tube, andsubject the emanation "operatorto a minimum exposure of radium emanation, said Linstii1mentcomprising a cannula havrng a tubular pierc ng end and provided at apoint initslength-inwardly of said end with a receiving opening in com- 7 munication with its bore, and an'ejector 5 comprising a, relatively stiff main'plunger.

portion slidably fitting in the bore of the cannula and a relatively flexible and resilent terminal extension carried b-yztheforward end of the main plunger portion andmade 1 j of wire toprovide the proper resiliency, the relatively stifi main plunger portion being adaptedto take. the first bend of thecystoscope, and the -resilientterminal extension.

the sharp and visible bend induced by the manipulation of the cystoscope elevator, said instrument when in use'permitting the free passage of the emanation seeds through the wardly, by the plunger. I i i 14. Incombination, "a cystoscope and an instrument for implanting seeds or tubes containing radium emanation in solid. tissue 1 and operating through said cystoscope, such implantation requiring extreme care in manipulatingthe, instrument in order to accurately radiate the diseased tissue, avoid:

loss of (the emanation tube, and subject the cannula bends when the seed is pushed forlbs .7

emanation operator to a minimum exposure I of radium emanation, said instrument comprising a'resilient cannula having a tubular piercing end and provided at a point in its length inwardly ofsaid end with a receiv-' ing opening in communication with its bore,

and a resilient ejector member slidably .fit-

to force the emanation tube therethrough under pressure and'into or; adjacent the In testimony whereo his signature. i j

. l e JOSEPH MUIR.

7 he hereunto afiixes end and provided at a point in its length in-.

wardly of said end with areceiving opening in communicatlon with its bore, an ln ector ting in the .bore of the cannula, and adapted 

